Physician Marriages

This article was originally published in American Medical News, the weekly newspaper of the American Medical Association. It is republished here by permission of the author, Flora Johnson Skelly.

Summary

• Not nurturing the relationship
• Marriages of male physicians
• Marriages of female physicians
• Getting help for marital problems
• 10 tips for improving your marriage.
• Warning signs of a marriage in trouble.

This information was originally published on April 11, 1994, in American Medical News, the weekly newspaper of the American Medical Association. It is offered here by permission of the author, Flora Johnson Skelly.

Dr. Michael Myers: An expert on physician marriages.

Michael Myers, MD, has a message for physicians: You are just as vulnerable to marital problems as anyone else.

The Vancouver, B.C., psychiatrist is the author of Doctors' Marriages: A Look at the Problems and Their Solutions (Plenum, 1994), an exhaustive overview of research on physician psychology and physician marriages and other committed relationships, from residency through retirement. Filling out this complex portrait are anecdotes and observations from more than 20 years of work with hundreds of physicians.

Dr. Myers teaches half time at the medical school at the University of British Columbia. He lectures on physician stress at medical schools and meetings throughout North America. The rest of his time is spent in a private practice devoted to physicians, residents, and medical students and their families.

Dr. Myers said today's diverse physician population has pretty much the same problems that everyone else does. But they are different in one significant way: Physicians tend to deny that they have problems -- physical, mental, or marital. Medical training inculcates an "us vs. them" mentality, he said, in which only patients are allowed to have problems. "We forget that we're human, too."

This tendency toward self-denial can have disastrous results. "Doctors tend to really let their health needs go. When they finally seek help, they're often in really rough shape."

That's why he wrote his book on physicians' marriages, said Dr. Myers in an interview conducted in his office at St. Paul's Hospital. (His private practice is conducted at another office located away from the hospital; doctors, he said, do not want others in the medical community to see that they are visiting a psychiatrist.)

He wants to encourage physicians to recognize marital problems where they exist and address them early. If professional help is needed, he wants physicians to not feel embarrassed about asking for it. "I wanted to make the whole subject `normal' or `legitimate.'"

Not nurturing the relationship

"I believe that all couples need an optimal amount of time together. What's `optimal' will differ from couple to couple. It even varies within the same couple from time to time. But if they dip below that level, couples often get into a circular pattern: The little bit of time they have together isn't pleasant. Then one or both of them starts to think, `I don't enjoy being with this person. I'm not sure I want to be with this person anyway.' So they avoid each other, which of course just worsens the problem."

In contrast, enjoyable time spent together will "buffer" the difficult times, Dr. Myers said. He often sees couples who have come to the conclusion that they no longer even like each other, when in reality "they may not have had enough time to really appreciate the good things about each other."

Due to the stresses of medical training and the early years of practice, this circular pattern can start early in physician marriages, said Dr. Myers. "The most common problems in the marriages of young physicians are not enough time together and not enough money. The two seem to go hand in hand, because the couple may be working extra hours to pay off educational debts. With couples like that, I point out that you've got to somehow budget for your marriage both in time and in money. Even if you can only go to a coffee shop and spend $1.50, you need to spend time together."

Male physician marriages

Male physicians are more prone to neglect their relationships and ignore warning signals of emerging problems. "It's very common for men to not worry about their marriages unless the messages are coming pretty strongly from the partner or wife that there's a problem. They tend to rationalize: `That's what it's like being married to a doctor.' Or `You can't have it both ways. You can't have all this money and a happy marriage too.'"

Sometimes these problems don't come to a head until the physician couple reaches middle years. Dr. Myers said. With the children out of the house or nearly so, the wife often feels that it's time for the husband to spend more time on the relationship. But the man may be used to spending his time elsewhere.

"I often see couples when the woman can't get the man to slow down or take a vacation, things like that. Sometimes all I have to do is get him to see the importance of doing what she suggests. I try to get them to talk, do more together, take up some hobbies together."

But by that time the problem of not spending enough time together may be complicated by other problems, he said. "She may have developed a drinking problem or be abusing medication."

Sometimes the wife seeks a separation. "More women are initiating separations than ever before," said Dr. Myers, "probably because women are more highly educated and more have remained in the work force at least part time."

When this happens, the husband may agree to or suggest marriage counseling. But it may be too late. "The woman says, `I've been trying to get him to go for marital therapy for years. He never would. Finally I went into therapy by myself and I realized that I don't need to live like this.' So they go to marital therapy for a few perfunctory visits, but the woman is psychologically already out of the relationship. She's down the road."

Men are often devastated by the end of their marriages, said Dr. Myers. He has seen so many men traumatized by their wives' decision to leave that he wrote a book about the phenomenon, Men and Divorce (Guilford Publications, 1989).

"Some of them are absolutely desperate. Not that women don't suffer through divorce. But almost always, the woman has a core group of women friends who are there for her. Whereas often the men have no one, or if they do have male friends they don't use them in that way or feel rebuffed if they try."

Their response, he said, is often to remarry quite quickly, often a younger woman. But these marriages can also be troubled. "If she grows and becomes her own person, she can find an older man too confining, too traditional. Men like that can feel quite abandoned."

But men who have been married and divorced do tend to be more alert to problems the second time around. "Many come to me and say, `When I was married before I buried my head in the sand.' The more insightful ones will say, `I can see things developing here that are very similar to what I experienced in my first marriage. I need to look at this.' That's good. That's somebody who is quite motivated to change."

Women physicians' marriages

Women physicians' marital problems are in some ways the reverse of those of male physicians, said Dr. Myers. Women in general are likely to see themselves as the caretakers of their marriages, and women physicians are no exception. Thus the problems of married women physicians tend to stem not from neglecting the relationship but rather from trying to stretch themselves too thin.

"Almost all women physicians have dual-career marriages. On top of their responsibilities as physicians, they tend to expect themselves or are expected to bear the responsibility for being executive managers of their homes, lining up childcare, and so on. They even write letters to his parents."

Women physicians may even find that, because they are physicians, their husbands expect them to not have the same emotional needs that other women do. Dr. Myers once had a patient whose husband told her, "I married you for your strengths, not your weaknesses."

Many of his women physician patients do have happy marriages, he said. "It depends a lot on who they're married to. If the man is truly someone who respects her as an equal and they try to carve out an egalitarian relationship as best they can, that helps tremendously."

But for many women physicians, the pressure of trying to be a tower of strength both as a physician and as a spouse can eventually get to be too much. Dr. Myers said he is encountering more and more women physicians who elect to divorce and remain unmarried. "Women who have been married before and are now separated often say, `I'm OK. I like my life. I have great women friends. I do a lot. I'm independent. The last thing I want is another husband.'"

Getting help

Many marital problems can be addressed through simple steps that do not require a professional's help. But physicians who do seek help should not feel that this is a personal failure, Dr. Myers said.

Many marital issues are so complicated that the help of an impartial observer is useful in sorting them out. These include sexual incompatibilities, disciplining of biological children in stepfamilies, excessive drinking, unresolved feelings over a previous affair, and changing sex roles and attitudes around the home.

Not every marriage should be saved. But physicians who do elect to work on their marriages are often quite successful at it, said Dr. Myers, whose book includes a discussion of different types of marital counseling.

Even physicians who initially were resistant to counseling typically become enthusiastic once they've tried it. "After the first visit I don't have any trouble getting them to come back. Some of the men who were the most nervous to be there initially become my most motivated patients once they realize that this is not that scary a place to be. They feel that to talk with a third party does seem to help."

But in order to get help, physicians must be willing to admit they have a problem. "I tell them, 'Pay attention to what you're feeling and try to figure out whether it's related to your marriage. And if you think you're not feeling anything, listen to your partner.'"

Ten tips for improving your marriage

1. Recognize and accept that there is a problem. "How a perceived problem is raised is critical. If you bring up a concern in a harshly dogmatic or accusatory way, you are almost guaranteeing that the concern will be denied or argued.... Using the first person plural, being tentative, and reporting feelings works better."
2. Acknowledge your part in creating and maintaining the problem. "It's always easier to `put it out there,' to see one's partner's role in it or to attribute all responsibility or blame to one's partner."
3. Try to really listen to your spouse. "Understand that the concerns are being aired in good faith, that he/she is trustworthy and not trying to render you `one down.'"
4. Learn to use and practice "active listening" techniques such as rephrasing comments your spouse has made and paraphrasing what you believe your spouse is trying to say.
5. Pay attention to personal and familial factors. "In a marriage there are times that may be more stressful (e.g., during residency or during certain types of residencies or rotations that have a lot of on-call and long working days)."
6. Set aside time as a couple on a regular basis ... at least weekly...for talk, relaxation, romance, and possibly sex. "I say `possibly sex' because it does not always follow from the other activities; and in most marriages sexual activity does not exist in isolation. You can't have healthy and mutually satisfying sex without verbal and emotional closeness."
7. Go out together as a couple at least once every two weeks. "Many couples find that they have their best talks outside of the home because there are no interruptions."
8. Cultivate other couples as close and trusted friends. "They will not only enhance one's socialization experience, but they will be there to share experiences common to all married couples in general and to medical couples in particular."
9. If you and your spouse identify a problem, do something about it. "Steps you may take include working fewer hours, learning to say `no' to more work, returning to work part time instead of full time, drinking less or stopping altogether, postponing a residency or fellowship, booking a vacation."
10. Try a marital enrichment experience. "Generally, these meetings are for marriage enhancement only and not for couples with severe problems. They are predicated on the premise that all marriages can use renewal, growth, and new learning."

Warning signs of a marriage in trouble

In you or your spouse

• Subjective symptoms such as feelings of tension and anxiety, insomnia, change of appetite, irritability, angry outbursts, and unhappiness.
• Increases in physical symptoms (headaches, chest pain, upset stomach, back pain) or exacerbation of preexisting psychosomatic disorders (peptic ulcer disease, asthma, migraine, rheumatoid arthritis).
• Increase in alcohol consumption or recreational drug use, or self- medicating with tranquilizers or painkillers.
• Persistent and serious fantasies of separation that last for weeks or months.
• Silence and emotional withholding.
• Physical withholding (no longer making affectionate gestures or wanting affection).
• Loss of sexual interest in spouse.
• Actively avoiding the spouse, not wanting to do anything together, not wanting to share or discuss anything except mundane events.
• An extramarital affair.
• Icy, wooden, or formal communication.

In both partners

• No longer "best friends."
• Bicker or nitpick over many matters.
• Argue more than usual, without resolution.
• Argue over the same issues over and over again.
• Arguing accelerates to fighting that becomes verbally violent -- with insults, name-calling, and threats -- or even leads to physical violence.
• Socializing is always with others, never as a couple alone together.
• Nothing to say to each other while together, or fear of nothing to say.
• Increasingly parallel or divergent lives.

Source: Doctors' Marriages by Michael Myers, MD.

Copyright © Flora Johnson Skelly, 1994.